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Background: Endotracheal intubation and laryngoscopy are harmful stimulus, which can trigger unwanted cardiovascular conditions such as hypertension, dysrhythmia, and tachycardia. Various drugs have been used to attenuate the cardiovascular response. Drugs such as clonidine and Gabapentin are in extensive usage to stabilize the hemodynamic responses. Aim and Objectives: The aim of the study was to assess the efficacy of 600 mg oral Gabapentin and 300 mcg oral clonidine in attenuating pre-operative anxiolysis and hemodynamic response to endotracheal intubation and laryngoscopy. Materials and Methods: This prospective randomized study consists of 100 cases between the age group 21 and 65 years posted for elective surgery under general anesthesia. The study cases were randomly divided into two groups. Group 1 (n = 50) administered with 600 mg oral Gabapentin and Group 2 (n = 50) administered with 300 mcg oral clonidine. The baseline and pre-operative hemodynamic parameters and levels of sedation score and anxiety scores were recorded. Results: The total duration of intubation was 26.53 min in Group 1 and 26.86 min in Group 2. The systolic blood pressure, diastolic blood pressure, mean heart rate, mean arterial pressure, sedation score, and anxiety score were comparable between the two study groups and the mean difference between the two study groups was statistically significant (P < 0.05). Conclusion: Both study drugs had similar significant anxiolysis and sedation scores. However, 300 ?g oral clonidine has better hemodynamic stability to laryngoscopy and intubation than 600 mg oral gabapentin.
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Objective@#To analyze the anesthetic effect of dexmedetomidine in laparoscopic D2 radical gastrectomy and its influence on hemodynamics, visual analogue scale (VAS) and Ramsay sedation score after operation.@*Methods@#A total of 86 patients who received laparoscopic D2 radical gastrectomy under general intravenous anesthesia in Shanxi Provincial Cancer Hospital from March 2017 to June 2017 were enrolled, and all the patients were divided into two groups by using random number table method. The observation group (43 cases) was intravenously injected with dexmedetomidine (0.6 μg/kg) before induction of general anesthesia, and the dose was changed to 0.4 μg/kg after 15 min with drug withdrawal till 30 minutes before surgery, the control group (43 cases) was given an equal volume of 0.9% normal saline. The mean arterial pressure (MAP) and heart rate change before anesthetic induction (T1), tracheal intubation time (T2), after intubation (T3), section time (T4) and the immediate time after intubation (T5) were compared between the two groups. The VAS and Ramsay scores at 1 h and 4 h after surgery and the intraoperative doses of anesthesia maintenance drugs were also compared between the two groups.@*Results@#The heart rate and MAP of the observation group were lower than those of the control group at the time of T1, T3-T5, the differences were statistically significant (all P < 0.05). The VAS and Ramsay scores of the observation group were better than those of the control group at 1 h and 4 h after operation, and the differences were statistically significant (all P < 0.05). The intraoperative doses of propofol and remifentanil in the observation group were (964±251) mg and (3.1±0.8) mg, respectively, which were less than those in the control group [(1 485±425) mg and (4.8±0.8) mg], the differences were statistically significant (t = 9.913, P < 0.01; t = 9.834, P < 0.01).@*Conclusion@#Dexmedetomidine can reduce the stress response of patients with laparoscopic D2 radical anesthesia, enhance the sedative effect, and reduce the dosage of propofol and remifentanil, therefore, it has high clinical application value.
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Objective To analyze the anesthetic effect of dexmedetomidine in laparoscopic D2 radical gastrectomy and its influence on hemodynamics, visual analogue scale (VAS) and Ramsay sedation score after operation. Methods A total of 86 patients who received laparoscopic D2 radical gastrectomy under general intravenous anesthesia in Shanxi Provincial Cancer Hospital from March 2017 to June 2017 were enrolled, and all the patients were divided into two groups by using random number table method. The observation group (43 cases) was intravenously injected with dexmedetomidine (0.6 μg/kg) before induction of general anesthesia, and the dose was changed to 0.4 μg/kg after 15 min with drug withdrawal till 30 minutes before surgery, the control group (43 cases) was given an equal volume of 0.9％normal saline. The mean arterial pressure (MAP) and heart rate change before anesthetic induction (T1), tracheal intubation time (T2), after intubation (T3), section time (T4) and the immediate time after intubation (T5) were compared between the two groups. The VAS and Ramsay scores at 1 h and 4 h after surgery and the intraoperative doses of anesthesia maintenance drugs were also compared between the two groups. Results The heart rate and MAP of the observation group were lower than those of the control group at the time of T1, T3-T5, the differences were statistically significant (all P< 0.05). The VAS and Ramsay scores of the observation group were better than those of the control group at 1 h and 4 h after operation, and the differences were statisticallysignificant (all P< 0.05). The intraoperative doses of propofol and remifentanil in the observation group were (964±251) mg and (3.1±0.8) mg, respectively, which were less than those in the control group [(1485±425) mg and (4.8 ±0.8) mg], the differences were statistically significant (t= 9.913, P< 0.01; t= 9.834, P< 0.01). Conclusion Dexmedetomidine can reduce the stress response of patients with laparoscopic D2 radical anesthesia, enhance the sedative effect, and reduce the dosage of propofol and remifentanil, therefore, it has high clinical application value.
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Background: Sedation is the depression of a patient’s awareness of the environment and reduction of his or her responsiveness to external stimuli. Some decades ago, the emergency room procedures were conducted without adequate sedation of the patient, which landed upon various bitter events, like uncomfortableness for the patient, uncomfortableness for the doctor, failure of the procedure, high rate of complications. Aim of the study: To study the onset of action, duration of action, and necessity of additive doses of sedation requirement of midazolam and propofol, to compare the sedative effects of OD midazolam and propofol. Materials and methods: This observational study was conducted in the division of Emergency Medicine at Rajah Muthiah Medical College and Hospital, Chidambaram in the year October 2017 to August 2018. After formal approval from the Ethical committee, this study was conducted on 40 G. Balaji, C.R. Ramachandran. Comparative study on sedative effects of midazolam and propofol in conscious, agitated, uncooperative patients those admitted in the Emergency Department of Rajah Muthiah Medical College and Hospital. IAIM, 2019; 6(5): 154-159. Page 155 patients of either sex between age 20 – 50 years old. After proper IV access is acquired, calculated doses of Midazolam or Propofol were administered intravenously and data was collected. Selection of drug (either midazolam or propofol) was random. The patients were sorted into two groups namely, Group M – Midazolam received patients. Group P – Propofol received patients. Then the data were collected regarding the onset of action, duration of action, sedation scales, and vitals. Scales used to evaluate the effect of drugs were the Richmond Agitation Sedation Scale (RASS), and Ramsay scale. Results: 32.5% of patients belong to toxicology by diagnosis and 30% of patients were pure medical cases, 15% belongs to hanging, and 7.5% of patients are trauma cases. 50% of patients were sedated for securing the airway, and 37.5% of patients were sedated to do procedures. 7.5% of patients received sedation to control seizures and 5% for Cardioversion. In Group P only 15% of patients required top-up dose, whereas in Group M 25% of patients required top-up dose. In Group P, the mean score was 4.35 and in Group M is 3.9, and so there is a statistically significant difference in the Ramsay scale. The difference in fall in systolic BP and respiratory rate between Group P and Group M was statistically significant. Also, there is a significant rise in SpO2 in Group P compared to Group M. Conclusion: Propofol-induced sedation is quicker and effective than that of midazolam. The side effects produced by propofol are negligible and it is even safer when top-up doses are used. The recovery from propofol-induced sedation is faster, and it is even smoother than that of midazolam. So propofol can be safely used for effective sedation in ER.
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Background: Dexmedetomidine is the newer highly selective alpha 2-adrenoreceptor agonist. It has sympatholytic, sedative and analgesic properties with no respiratory depression. Various studies have evaluated the usefulness of Dexmedetomidine as an adjuvant to general anesthesia, reducing the requirements of inhalational agents and opioids, and for attenuating the intubation stress. A single dose of Dexmedetomidine has been found effective in attenuation of the airway and circulatory reflexes during extubation. Aim of the study: To compare the effects of intravenous Dexmedetomidine and lignocaine on Attenuation of hemodynamic responses and sedation score, Attenuation of airway responses to extubation after intracranial surgeries under general anesthesia. Materials and methods: This was a prospective, randomized, double-blinded study conducted at our institute between June 2018 and July 2018 in Tirunelveli government medical in the department of anesthesiology after getting institutional Ethical committee approval. Written informed consent was obtained from all subjects participating in the study. 50 patients of ASA Grade I and II undergoing craniotomies for non‑vascular ICSOL under general anesthesia were recruited. Patients were divided into two groups of 25 each by computer-generated random numbers. Group D (n=25) received 0.5 microg/kg Dexmedetomidine intravenously. Group L (n=25) received 1.5 mg/kg Lignocaine intravenously. Anesthesiologist who administered the drug and the observer were blinded to the study. Intravenous drugs were prepared by another anesthesiologist not involved in the study. Ebenezer Joel Kumar E, G Vijay Anand, B.S. Aswathy R. A comparative study of the effect of dexmedetomidine and lignocaine on hemodynamic and airway responses following extubation. IAIM, 2019; 6(2): 79-86. Page 80 Results: A decrease in HR, SBP, and DBP were observed up to the A5 stage in group D which was statistically significant. In group L the changes in HR, SBP, and DBP at these stages were statistically insignificant. There was an increase in HR, SBP and DBP in both groups during (E) and immediately after extubation (E1). This was more in group L compared to group D which was statistically significant. Thereafter in group D these values continued to decrease and remained below the pre-drug administration value (A0) at the end of the study (E15). Whereas in group L, these values although decreased from E and E1 values but remained above the A0 values at the end of the study period (E15). This difference was statistically significant (p-value less than 0.05). The degree of sedation was higher in Group D after extubation. 5 patients (20%) showed Grade 2 sedation and 20 patients (80%) showed Grade 3 sedation in Group D. In contrast, only 20% (n=5) patients had mild sedation (Grade 2) whereas 80% (n=20) patients were anxious and agitated or restless or both (Grade 1) in group L. The difference between both groups was statistically significant. Conclusion: From our study, we concluded that administration of a single dose of Dexmedetomidine (0.5 mcg/kg) provides significant attenuation of circulatory and airway responses during extubation when compared to lignocaine in craniotomies for ICSOL. Though patients were sedated in the immediate post-extubation period, the levels of sedation were acceptable without any incidence of desaturation
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Objective@#To observe the analgesic and sedative effect and safety of application of dexmedetomidine combined with remifentanil in dressing change of conscious patients with non-intubation in burn intensive care unit.@*Methods@#Forty patients conforming to the study criteria hospitalized in our burn intensive care unit from April 2015 to April 2017 were selected. Prospective, randomized, and double-blind method was used for the design. Patients were divided into dexmedetomidine group and dexmedetomidine+ remifentanil group according to the random number table, with 20 cases in each group. Patients in the two groups were respectively given corresponding drugs during dressing change. The frequency and time of dressing change, Verbal Rating Scale (VRS) score of patients during dressing change (at drug administration for 25 minutes) and after dressing change (25 min after dressing change), Ramsay Sedation Score (RSS) during dressing change, satisfaction level for anesthesia of the patients and physicians after dressing change, dosage of remifentanil, and various adverse effects during and after dressing change were recorded. The heart rate, mean arterial blood pressure (MAP), respiratory rate, and pulse oxygen saturation (SpO2) before drug administration and at 10, 15, and 25 minutes after drug administration were also recorded. Data were processed with analysis of variance for repeated measurement, t test, chi-square test, and Fisher′s exact probability test.@*Results@#(1) Totally 38 patients completed the trial. There were no statistically significant differences between patients in two groups in gender, American Association of Anesthesiologist Grading, age, weight, and total burn area (χ2=0.230, 0.146, t=0.224, 0.351, 0.367, P>0.05). (2) The frequency of dressing change of patients in two groups were both 48 times. The time of dressing change and VRS scores during dressing change of patients in two groups were similar (t=0.821, 1.522, P>0.05). The VRS score of patients in dexmedetomidine+ remifentanil group after dressing change was (3.1±0.4) points, obviously lower than (3.8±0.8) points in remifentanil group (t=2.213, P<0.05). The RSS, satisfaction level scores for anesthesia of the patients and physicians after dressing change in dexmedetomidine+ remifentanil group were (3.13±0.32), (3.44±0.41), and (3.13±0.25) points, respectively, obviously better than (1.82±0.24), (2.71±0.23), (2.53±0.41) points in remifentanil group (t=2.226, 2.684, 7.702, P<0.01). The dosage of remifentanil of patients in dexmedetomidine+ remifentanil group was (282±19) μg, obviously less than (340±31) μg in remifentanil group (t=9.896, P<0.01). There were no statistically significant differences between patients in two groups in rates of respiratory inhibition and hypotension (χ2=0.211, 0.154, P>0.05). Compared with those in remifentanil group, the rates of nausea, vomiting, and other gastrointestinal symptoms of patients in dexmedetomidine+ remifentanil group were obviously reduced (P<0.05), but the rate of bradycardia was obviously increased (χ2=6.008, P<0.05). (3) There were no statistically significant differences between patients in two groups in heart rate, MAP, respiratory frequency, and SpO2 before drug administration (t=0.444, 0.892, 1.059, 1.039, P>0.05). The heart rates of patients in dexmedetomidine+ remifentanil group at 10, 15, and 25 minutes after drug administration were (83±11), (78±10), and (82±14) times per minute, respectively, significantly lower than (95±10), (87±12), and (89±12) times per minute in remifentanil group (t=5.592, 3.992, 2.630, P<0.05 or P<0.01). The MAP of patients in dexmedetomidine+ remifentanil group at 15 and 25 minutes after drug administration were (69.4±3.1) and (73.8±2.2) mmHg (1 mmHg=0.133 kPa), respectively, significantly lower than (75.4±3.0) and (78.1±3.5) mmHg in remifentanil group (t=9.181, 7.206, P<0.01). There were no statistically significant differences between patients in two groups in respiratory frequency at each time point after drug administration (t=1.489, 1.862, 1.963, P>0.05). The SpO2 of patients in dexmedetomidine+ remifentanil group at 15 minutes after drug administration was 0.972±0.018, obviously lower than 0.979±0.015 in remifentanil group (t=2.070, P<0.05).@*Conclusions@#Application of remifentanil with small dosage has effective analgesia for conscious burn patients with non-intubation during dressing changes, however, adverse effects such as nausea and vomiting are likely to occur. Remifentanil combined with dexmedetomidine not only guarantee the analgesic effect, but also reduce the dosage of analgesics, improve the sedative effect and satisfaction of the patients for anesthesia, and reduce various adverse effects. However, it will increase the incidence of bradycardia and has some inhibition effect on circulation at the same time.
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Introduction: Post-operative pain and swallowing difficulty following tonsillectomy remain one of the most difficult pain states to manage in Otolaryngology. Many therapeutic modalities - ranging from non-steroidal anti-inflammatory drugs (NSAIDs) to systemic opioids, acetaminophen, and tramadol - have been used for posttonsillectomy pain control in patients. Gabapentin has been recently found to be useful for reducing acute post-operative pain when administered preoperatively. Although various dose regimens have been tried in different surgical settings, the minimum effective dose is not established. The aim of the study: To study the analgesic property of a single of dose oral Gabapentin for postoperative pain relief, to study the hemodynamic variables in patients receiving oral Gabapentin Materials and methods: A total number of, 60 patients were included in the study group between 6 to 16 years. P group (Placebo group) 30 ASA I patients for tonsillectomy receiving oral placebo, G group 30 ASA I patients for tonsillectomy receiving oral gabapentin during a 24-hour post-operative period, the outcomes of interest being postoperative pain intensity; rescue analgesic consumption; or adverse effects such as sedation, nausea and vomiting, dizziness, and headache. Results: The pain score reported by the physician during the first 8 hours, as well as the need for analgesics during 24 hours postoperatively, were significantly decreased in the gabapentinoids group versus the control group. Additionally, there was no significant difference between gabapentinoids and control groups for adverse effect during 24 hours postoperatively. Statistically, significant Paul Praveen, Ranjini O.M., T. Murugan. Single dose oral gabapentin as a pre-emptive analgesic for post-operative pain relief in patients undergoing tonsillectomy. IAIM, 2018; 5(5): 27-32. Page 28 sedation was observed up to 4 hours in the postoperative period. After 5 hours there was no statistically significant difference in both groups. Conclusion: Oral Gabapentin is effective for postoperative pain relief, reduces the requirement of supplementary analgesics in the postoperative period. Oral Gabapentin has a better hemodynamic profile. Gabapentin is safe for use in pediatric patients.
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Objective To assess the accuracy of bispectral index (BIS) in monitoring the sedation level with dexmedetomidine combined with small-dose of sufentanil.And, to analyze the BIS value of the best opportunity for invasive manipulation with this sedation method.MethodsEighty elective operation patients, ASA Ⅰ~Ⅱ, were randomLy selected for the study.Before the start of anesthesia, small-dose of sufentanil 0.1μg/kg and dexmedetomidine were injected in vein in sequence.The loading dose of dexmedetomidine was 1.0μg/kg for 15 min and the maintenance dose was 0.3μg/kg for 5 min.The time-pint before the start of injection was recorded as T0.And, T1, T2, T3, and T4 respectively presented the infusion time of dexmedetomidine for 5min, 10min, 15min and 20min.According to these four time-points, 80 patients were randomLy divided into four groups: group T1, group T2, group T3,and group T4.The relevant HR, MAP, SpO2, BIS value, and OAA/S score were separately recorded.Analyze the correlation of BIS and OAA/S score, and the cutoff value of BIS for OAA/S score=1 was obtained by analyzing receiver operating characteristic (ROC) curve.ResultsThe compound use of dexmedetomidine and sufentanil significantly decreased HR.With this sedation method, BIS value was positively correlated with OAA/S score (r=0.95), and the best cutoff value of BIS values for OAA/S score=1 was 44.5.ConclusionThere was a good correlation between BIS and OAA/S score in monitoring sedation with dexmedetomidine combined with small-dose of sufentanil.BIS=44.5 could be regarded as a good monitoring index of invasive manipulation with this sedation method.
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Background: Pain is regarded as a complex experience consisting of sensory, physiological, psychological and behavioral components. Management of pain can be best achieved by an approach that takes into consideration, the complex interactions between psychological, biological and sociocultural factors. Effective pain management requires thorough preparation of the patient and a structured inpatient service for prevention of postoperative pain. Local anesthetic Ropivacaine is preferred nowadays for epidural postoperative analgesia as it has favorable sensory block profile. The aim of the study: The aim of the study was to compare the postoperative analgesic efficacy of epidural Ropivacaine and Ropivacaine with Tramadol in adults undergoing abdominal surgeries under general anesthesia. Materials and methods: A total of 60 patients were included in the study. Patients were divided into two groups of 30 in each into group R and group RT The study was a prospective non-randomized, double arm, single-blind, controlled study. The sample size was determined based on the study Postoperative analgesic efficacy of epidural Tramadol and adjuvant to Ropivacaine in adult upper abdominal surgeries” Patients who satisfied the above-mentioned inclusion criteria selected were B Saravanakumaran, S.R. Pradeepa. Comparison of postoperative analgesic efficacy of epidural ropivacaine and ropivacaine with tramadol in adults undergoing abdominal surgeries under general anesthesia. IAIM, 2017; 4(11): 76-84. Page 77 counseled about the risks and benefits involved in the study. After getting consent, patients who were willing to be included in the study were enrolled and analyzed. Results: Our study showed the increased mean duration of postoperative analgesia, Ramsay sedation score in Ropivacaine with Tramadol group compared to the Ropivacaine group was statistically significant at the p-value was <0.0001. The association between pruritus status and intervention groups was considered to be nonsignificant since p-value was >0.05 as per Fisher's exact test. The association between heart rate, mean peripheral capillary oxygen saturation, mean respiratory rate in intervention groups was considered to be non-significant since p-value was > 0.05 as per unpaired ttest. Conclusion: From my study, I conclude that the addition of 1 mg/kg of Tramadol improves the postoperative analgesic efficacy of epidural 0.2% Ropivacaine by prolonging the duration of analgesia and providing good sedation with no significant hemodynamic alterations, nausea, vomiting and pruritus
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Background: Caudal analgesia with bupivacaine and several adjuvants is a very popular in pediatric anesthesia for providing intra- and post-operative analgesia. Methods: This randomized comparative prospective study of total 60 patients of either sex, of ASA Grade I or Grade II, aged between 01 and 12 years, undergoing elective lower abdominal or perineal surgeries were enrolled after written and informed consent. 60 patients undergoing general anesthesia with laryngoscopy and endotracheal intubation followed by caudal anesthesia for post-operative pain relief were randomly allocated into two groups of 30 patients each, Group B received caudal analgesia with 0.25% plain bupivacaine 0.75 ml/kg and Group C received caudal analgesia with 0.25% bupivacaine 0.75 ml/kg with clonidine 1.5 μg/kg after induction of anesthesia but before starting surgery. Intraoperatively heart rate (HR), systolic blood pressure (SBP), and diastolic BP (DBP) were monitored while in post-operative period we monitored following-objective pain score, sedation score, HR, SBP and DBP and any side effects like post-operative nausea and vomiting, respiratory depression in both the groups. The final results of the study were tabulated and analyzed for significance using standard statistical techniques (2 independent sample t-tests). Sedation score was analyzed by using Mann–Whitney test. Results: The objective pain score was significantly lower, and sedation score was significantly higher in bupivacaine with clonidine group. The HR, SBP, and DBP were significantly on the lower side with bupivacaine with clonidine group when compared to plain bupivacaine group, but bradycardia was not statistically significant. Hemodynamic stability and post-operative pain-free period in bupivacaine with clonidine group was more than plain bupivacaine group which was beneficial in surgeries like hypospadias repair. Conclusion: Single shot caudal epidural with the addition of clonidine to bupivacaine is efficient in prolonging the duration of analgesia of plain bupivacaine with minimal or no side effect.
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Background: Providing adequate anxiolysis and sedation with a patent airway while performing fiberoptic bronchoscopic intubation is a challenging task to an anaesthetist. Ideal sedation would ensure calm and cooperative patient maintaining spontaneous ventilation. Dexmedetomidine is such a α2a adrenergic agonist with sympatholytic, analgesic, and sedative properties. Though its role is very well documented for sedation, proving it better than propofol for the procedure is being considered in this study. Methods: In total of 60 patients, after nebulizing with 5 ml of 4% lignocaine over 10 minutes, 30 patients were infused with dexmedetomidine @1μg/kg over 10 minutes followed by 0.3μg/kg and rest with propofol @1mg/kg. Fiber-optic bronchoscopy was done after 10 minutes of infusion. Monitoring was done considering heart rate, blood pressure, Ramsay sedation score and patient tolerance. Results: had shown successful intubation in both cases but dexmedetomidine had a better outcome with respect to sympathetic response and patient tolerance. P value was significant for sedation score, pre and post bronchoscopic intubation sympathetic response. No episodes of airway obstruction and hypoxia were noted with dexmedetomidine as compared with propofol. Mean Ramsay sedation score was 3.77 as compared to 2.33 with propofol. Conclusion: In our comparative study, Dexmedetomidine had offered better patient tolerance with adequate sedation and preservation of airway as compared to propofol and a reduced hemodynamic response to intubation.
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BACKGROUND: There have been recent reports on the effects of the addition of intrathecal midazolam to bupivacaine on spinal anesthesia. Therefore, the effects of the addition of intrathecal midazolam to bupivacaine on spinal anesthesia and peri-operative sedation were investigated. METHODS: Thirty one ASA class 1 and 2 patients, scheduled for transurethral resection of the bladder or prostate (TURB or TURP), were randomly divided into two groups. Group B (n = 15) received bupivacaine 12 mg, and normal saline 0.6 ml, whereas group BM (n = 16) received bupivacaine 12 mg, midazolam 2 mg, and normal saline 0.2 ml. The blood pressure (BP), heart rate (HR), arterial oxygen saturation (SaO2), bispectral index (BIS) and Observer's Assessment of Alertness/Sedation Scale (OAA/S scale) scores were recorded every 5 minutes, both before and during the spinal anesthesia. The sensory blockade was measured using a pin-prick test, and motor blockade evaluated using the Bromage motor scale. In addition, the side effects, including pruritus, nausea, vomiting, and headache, and so on, were observed for a period of 24 hours. RESULTS: There were no differences in the motor and sensory block and recovery between the two groups. However, a difference was found in the time to first recognition of pain and the BIS scores between the two groups. CONCLUSIONS: Intrathecal midazolam did not, itself, affect the spinal anesthesia, but was found to have a statistically prolonged postoperative analgesic and more sedative effects.
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Humans , Anesthesia, Spinal , Blood Pressure , Bupivacaine , Headache , Heart Rate , Hypnotics and Sedatives , Midazolam , Nausea , Oxygen , Prostate , Pruritus , Urinary Bladder , VomitingABSTRACT
PURPOSE: We examined the relationship between BIS, sedation score and plasma midazolam concentration to verify the usefulness of BIS to assess the patient's consciousness during sedation. PATIENTS AND METHODS: Twenty-five young, healthy adult volunteers participated in this clinical study. Midazolam was administered intravenously up to 0.08 mg/kg to induce unconsciousness and we monitored the patient's physiological and conscious status until complete recovery from sedation. BIS and sedation score were measured before sedation, 10, 20, 30 minutes after midazolam administration. Plasma midazolam concentration was measured 10 minutes after midazolam administration. BIS was measured using A-2000 BISTM monitor (Aspect Medical Systems, USA) and the degree of sedation was evaluated with the sedation score. RESULTS: The BIS score correlated with the sedation score (r = 0.676, P < 0.05). With the decreased plasma midazolam concentration, the correlation was better with sedation score(r = -0.656).Although BIS values did not correlate with calculated plasma concentration of midazolam (r = 0.467) at 10 minutes after midazolam administration, values after sedation were well distinguished from those before sedation. CONCLUSIONS: BIS is known for an effective predictor of patient's hypnotic state, and it is correlated with the sedation score. But, it doesn't always coincide with the clinical parameters of depth of sedation. So more attention is needed using BIS only during sedation, and it is advisable that the patient's consciousness is monitored with variable sedation score systems every several minutes.